桡神经内移在肱骨干骨折固定中的应用

Medial transposition of the radial nerve in humeral shaft fractures fixation

目的:总结桡神经内移在肱骨干骨折固定中应用的结果。方法:2005年1月至2009年12月,对16例肱骨干骨折患者,在行前外侧钢板固定中应用桡神经内移方法治疗。其中,男12例,女4例;年龄26～49岁,平均36岁。左侧9例,右侧7例。根据AO骨折分类:6例为A3.2型,5例为A2.2型,2例为A1.2型,3例为B2.2型。应用美国骨科医师协会提出的DASH量表进行疗效评定,0表示上肢功能正常,1～100表示上肢功能有不同程度的损伤。结果:16例患者术后没有发生与手术相关的并发症,无神经损伤与伤口感染。术后随访20～46个月,平均29个月。上肢功能按DASH上肢功能量表评定,均达到了正常数值(数值为0),取得了满意的临床效果。结论:桡神经内移是一种安全的操作方法,不会引起医源性神经损伤,不影响对骨折的处理。在对肱骨干骨折行开放复位以及前外侧钢板固定中,该手术方法可防止桡神经受损伤。

Objective：To summarize clinical outcomes of using medial transposition of the radial nerve in humeral shaft fracture fixation. Methods：From January 2005 to December 2009,16 patients with humeral shaft fractures were treated with medial transposition of the radial nerve during open reduction and anterolateral plate fixation, included 12 males and 4 females ranging in age from 26 to 49 years,with a mean of 36 years. There were 7 fractures in the right and 9 in the left. According to AO classification, 6 fractures were type A3.2,5 fractures were type A2.2,2 fractures were type A1.2 and 3 fractures were type B2.2. The results were evaluated with DASH （disability of arm-shoulder-hand） Questionnaire by the American Academy of Orthopedic Surgeons （AAOS） ,where 0 indicates normal upper extremity function,and 1 to 100 indicate varying degrees of damage to the function of the upper extremities. Results： There was no neurologic complication or postoperative would infection in this series. The followed-up period ranged from 20 to 46 （means 29） months postoperatively. The clinical outcomes were e- valuated with DASH Questionnaire, indicating that all patients reached a normal value （value of 0）. The function of the upper extremities recovered satisfactorily. There was no surgery-related complication. Conclusion ：Medial transposition of the radial nerve is safe and does not cause iatrogenic nerve injury. It protects the radial nerve during open reduction and anterolateral plate fixation of humeral shaft fractures.